Department of Physiotherapy, SHUATS

1. HEPATITIS - B
COMMUNITY MEDICINE
SUBMITTED TO-
MRS. SURABHI SRIVASTAVA
ASSISTANT PROFESSOR
DEPARTMENT OF PHYSIOTHERAPIEST
SUBMITTED BY-
RADHIKA TIWARI
I’D NO- 21BPHY 008
BPT- 3RD YEAR

2. The Silent Threat:
Unmasking
Hepatitis B

3.  Hepatitis B virus (HBV) infection is a global public
health problem.
 It is estimated that there are more than 350 million
HBV carriers in the world, of whom 1 million will die
annually from HBV-related liver disease.
 Some references have placed the number of affected
persons as much as 5% of the total world population.
 In the United States, there are an estimated 1.25
million hepatitis B carriers, defined as persons
positive for hepatitis B surface antigen (HBsAg) for
more than 6 months.
 The spectrum of clinical manifestations of HBV
infection varies in both acute and chronic disease.
 During the acute phase, manifestations range from
subclinical hepatitis to fulminant hepatitis.
 During the chronic phase, manifestations range from
an asymptomatic carrier state to cirrhosis, and
hepatocellular carcinoma.
Hepatitis B is the
most common
serious liver
infection in the
world. It is caused
by the hepatitis B
virus that attacks
and injures the
liver. Two billion
people (or 1 in 3)
have been infected
and about 300
million people are
living with a
chronic hepatitis B
infection. Each year
up to 1 million
people die from
hepatitis B despite
the fact that it is
preventable and
treatable.

4.  Hepatitis B is transmitted through direct contact with
infected blood or certain bodily fluids. The virus is most
commonly transmitted from an infected pregnant person
to their baby during childbirth, due to the blood exchange
that happens between mother and baby. It is also
transmitted through unsterile medical or dental
equipment, unprotected sex, or unsterile needles, or by
sharing personal items such as razors, toothbrushes, nail
clippers, body jewelry.
 Hepatitis B is a “silent epidemic” because most people do
not have symptoms when they are newly infected or
chronically infected. Thus, they can unknowingly spread
the virus to others and continue the silent spread of
hepatitis B. For people who are chronically infected but
don’t have any symptoms, their liver is still being silently
damaged which can develop into serious liver disease such
as cirrhosis or liver cancer.

5. Hepatitis B Clinical Features
● Incubation period 60 to 90 days
● Clinical signs and symptoms more common in adults
● Prodromal phase lasts 3 to 10 days; abrupt onset of fever, malaise,
anorexia, nausea, abdominal discomfort, and dark urine before
jaundice
● Icteric phase lasts 1 to 3 weeks; jaundice, light or gray stools, hepatic
tenderness, hepatomegaly
● Convalescent phase lasts weeks to months; malaise and fatigue
persist while jaundice, anorexia, and other symptoms disappear
● Most adults recover while most infants progress to chronic infection

7. Chronic Hepatitis B Virus Infection (HBV)
● Proportion of persons with acute HBV that progress to chronic HBV
■ As many as 90% of infants
■ 30% to 50% of children between age 1 and 5 years
■ 5% of adults
● Often asymptomatic
● Responsible for most HBV-related morbidity and mortality
● 25% of persons infected as children and 15% of persons infected as adults will die prematurely

9. Panel A
 shows HBV virions (Dane
particles) and filaments.
Panel B
shows 20-nm HBsAg
particles

15. Hepatitis B Epidemiology
● Reservoir
■ Human ■ Some primates
● Transmission
■ Body fluids (highest concentration in blood
and serous fluids)
● Temporal Pattern
■ No temporal pattern
● Communicability
■ Persons with acute or chronic HBV infection
are infectious any time HBsAg present in blood
■ Persons with acute HBV infection can have
HBsAg in blood 1–2 months before and after
onset of symptoms

16. Epidemiology Occurrence
HBV infection occurs worldwide. The frequency of infection varies
in different parts of the world but is more common in some
countries in Asia, Africa, South America, and the Caribbean.
Reservoir HBV infection affects humans. Additionally, some
primates (chimpanzee, gorilla, orangutan, gibbon) in Africa and
Southeast Asia are infected with HBV. Transmission HBV is
transmitted by parenteral or mucosal exposure to HBsAg-positive
body fluids from persons who have acute or chronic HBV
infection. The highest concentrations of virus are in blood and
serous fluids; lower titers are found in other fluids, such as saliva,
tears, urine, and semen. Semen is a vehicle for sexual
transmission and saliva can be a vehicle of transmission through
bites; other types of exposure (e.g., to saliva through kissing) are
unlikely modes of transmission.

17. Vaccination Schedule and UseInfants
and Children HepB vaccination is recommended for all medically stable infants weighing at least 2,000
grams within 24 hours of birth. Only single-component vaccine should be used for the birth dose and
doses administered before age 6 weeks. The usual schedule is 0, 1 through 2, and 6 through 18 months. All
pregnant women found to be HBsAg-positive should have their sera tested for HBV DNA. If HBV DNA
levels are greater than 200,000 IU/mL, Tenofovir (preferable) or lamivudine should be administered to the
pregnant woman starting at the beginning of the third trimester and continued one to three months after
birth. Infants born to mothers who are HBsAg-positive should receive the HepB vaccine birth dose and
HBIG within 12 hours of birth. HepB vaccine and HBIG should be administered in separate limbs. For
infants weighing less than 2,000 grams, the birth dose should not be counted as part of the vaccine series
because of potentially reduced immunogenicity; 3 additional doses of vaccine (for a total of 4 doses)
should be administered beginning when the infant reaches age 1 month.

18.  Reduced atrophy – Strength-training supports muscle
growth and maintenance which can prevent or delay
the severe muscle wasting seen in advanced liver
disease.
 Improved energy – Over time, regular exercise
improves the efficiency of the Cardiovascular
System This improves delivery of oxygen and
nutrients to all cells, tissues, organs and systems,
which leads to a higher energy level[7].
 Exercise program - include aerobic/cardiovascular
conditioning and strength training to have the
greatest effect on liver function.
•Aerobic exercises like walking, bicycling, jogging and
swimming will improve your cardiovascular system’s
ability to oxygenate your blood and deliver it to the liver
and the rest of the body.
•Strength training helps maintain bone mass, increases
muscle strength and mass, and helps prevent weight
gain through elevation of the metabolism.
•Construct a great home exercise program.
Role of physiotherapy